Health Workforce Development
An Overview
Published in April 2006 by the
Ministry of Health
PO Box 5013, Wellington, New Zealand
ISBN 0-478-29960-5 (Internet)
HP 4247
This document is available on the Ministry of Health’s website:
http://www.moh.govt.nz
Acknowledgements
The Ministry would like to thank Ruth Hamilton, of Vital Signs Consulting, for her work on the preparation of this report.
Contents
Executive Summary iv
Introduction 4
Background 4
Structure 4
Part 1: The Environment for Workforce Development 4
1.1 Factors influencing demand for health and disability support services 4
1.2 Government agencies involved with health workforce development 4
1.3 Health workforce education and training 4
1.4 The New Zealand labour market 4
1.5 Characteristics of the health and disability workforce 4
1.6 Workforce shortages 4
Part 2: Approaches to Workforce Development 4
2.1 Can the health labour market be changed? 4
2.2 Health workforce culture and innovative models of care 4
2.3 International approaches to workforce development 4
2.4 The New Zealand approach to workforce development 4
2.5 Mental health and addiction workforce development 4
Part 3: Key Themes for the Shape of Future Workforce Development in New Zealand 4
3.1 Workforce development infrastructure 4
3.2 Organisational development 4
3.3 Recruitment and retention 4
3.4 Training and development 4
3.5 Information, research and evaluation 4
3.6 Leading change 4
Appendices
Appendix 1: Summary of Priorities in DHB/District Health Boards of New Zealand (DHBNZ) Future Workforce 2005–2010 Document 4
Appendix 2: New Zealand Workforce Innovation Projects 4
Appendix 3: Some International Perspectives on Workforce Development 4
Appendix 4: Ministry of Health Workforce Development Actions 4
Glossary 4
References 4
Executive Summary
The environment for workforce development
Demographic change is a major driver of demand for health services. Between 2001 and 2021 it is predicted that the New Zealand population over 65 will increase from 461,000 to 729,000. Most significantly, in this period the population aged over 85 is predicted to grow from 48,639 to 105,400. The proportion of Māori and Pacific older people will also grow substantially.
Government strategies such as the Primary Health Care Strategy (Minister of Health 2001) require the workforce to work in new ways. They require a population-based approach to health care provision which emphasises prevention, education, health maintenance and wellbeing, and strengthening of connections with other health agencies, social and community services, and iwi. These strategies also emphasise improving the cultural appropriateness of services, the promotion of inclusive and consumer-centred approaches to service provision, and the development of new health care services and roles in the community.
Finally, health consumers in developed countries now have much greater access to information about health, and consequently greater expectations about what the health care system can potentially deliver for them. Those expectations are further amplified by the ‘medicalisation of wellbeing’ (Gorman and Scott 2003) and the publicity about technological developments that can improve treatment outcomes. All of these factors influence the kind of workforce that New Zealand will need in the future.
Health sector workforce regulation affects the shape of the workforce by setting and reinforcing the parameters for accountability. The Health Practitioners Competence Assurance Act 2002 (HPCAA) requires registration authorities to ensure that practitioners are competent and fit to practise their professions. It is also possible to develop and register new, different and/or overlapping professional scopes of practice under the HPCAA to support developments in services and in practitioner roles. Contractual requirements and collective employment agreements also define the roles and activities of occupational groups.
The Health Workforce Advisory Committee (HWAC) was set up under the New Zealand Public Health and Disability Act 2000 to advise the Minister on workforce issues. The HWAC also has a Māori Health and Disability Workforce Subcommittee and a Medical Reference Group.
District Health Boards New Zealand (DHBNZ), on behalf of DHBs, has developed a collaborative workforce development framework, based on a workforce action plan that focuses on information, relationships and strategic capability. The DHB/DHBNZ Future Workforce framework, developed in 2005, has identified future workforce needs and priorities for action. This framework is driven by collaborative mechanisms set up by DHBs, including the DHB/DHBNZ Workforce Development Group (WDG) and six workforce strategy groups, which provide capacity and leadership for the development of key workforces and report to the WDG.
The Ministry of Health’s role in this is to ensure that the policy and regulatory environments support the Government’s strategic objectives, and to provide leadership and support to the sector on workforce development. Work includes the development of workforce action plans targeting various sectors.
The education sector is responsible for funding health workforce education through the Tertiary Education Commission, and clinical training is generally funded through the Ministry’s Clinical Training Agency. DHBs also play a significant role in the clinical training of registered health practitioners. A stocktake of the provision of education in the 2002 year identified that the Commission’s funding was $191.2 million, Clinical Training Agency funding was $86.6 million, and DHB funding was $15 million (Ministry of Health and Tertiary Education Commission 2004).
Approaches to workforce development
The most significant change facing the New Zealand labour market over the next 25years is that many more workers will retire than will be recruited. In addition, current projections suggest that Māori and Pacific people will make up a greater proportion of the workforce, and there is an increasing mobility of professionals in the global labour market.
Overall, there is a lack of good data to profile the health workforce itself. The HWAC stocktake report (HWAC 2002) estimated that there were 43,510 nurses and medical practitioners, making up 65% of the 67,000 registered practitioners. The rest of the workforce comprised 30,000 support workers and 10,000 alternative and complementary health workers. Subsequent research has raised the estimate of disability workers in the community and residential care to approximately 45,000 (Ministry of Health 2004c, 2004d). In 2004 the New Zealand Institute of Economic Research estimated the total size of the health and disability workforce (registered and unregistered) as around 130,000 (NZIER 2004).
The health workforce is part of the overall New Zealand workforce and shares many of the same features, including the effects of changes in demand and supply. However, it is may be difficult to utilise the strategies that private firms can use in response to skill shortages. Occupational regulation may limit flexibility, service coverage obligations may limit changes being made to services, budget constraints may limit the ability to respond to changes in demand or labour market conditions, and capital constraints may limit options to substitute capital and technology for labour.
There have been reported shortages in both the regulated and unregulated workforce, in particular of medical practitioners, nurses in primary care, mental health professionals, allied and primary health professionals, Māori and Pacific practitioners, and support workers. There is also an ongoing issue of a maldistribution of workers between rural and urban locations. There are few short-term strategies available when the labour market is tight. These are primarily immigration, attracting ex-practitioners back into the health sector, reducing turnover and improving productivity.
In terms of future demand, a report produced for the Ministry, Ageing New Zealand and Health and Disability Services: Demand projections and workforce implications, 2001-2021 (NZIER 2004) predicts that if health and disability services were to retain their current share of the working-age population, demand for labour will outstrip supply by 2011. The excess of labour demand over supply would be between 28% and 42% of the 2001 workforce by 2021. These predictions paint a worst case scenario. They point to the importance of workforce development in ensuring that health and disability services will continue to be available in line with public expectations.
Professional organisations, representative bodies and unions have a significant affect on the demand for and supply of registered health workers. They tend to view health sector development through a discipline-based lens and to advocate for particular professional practice standards, service models and work design. This contributes to a push for increasing specialisation and increasing levels and length of education.
The methods for determining workforce shortages tend to assume that the structure of the workforce is set, and ignore the potential for substitution between roles, opportunities for new roles and the impact of developing technologies and practices. In New Zealand, workforce planning since the 1980s has been largely focused on various ways to predict discipline-specific demands.
A review of workforce planning approaches in Australia, France, Germany, Sweden and the UK in 2003 identified similar limitations. Since then England, Scotland and Australia have developed national workforce development frameworks which focus on improving knowledge about the workforce, promoting entry to the workforce, developing the unregulated workforce, developing career pathways, promoting innovation, and aligning health education and training with sector needs.
In the future, the constraints on labour supply in New Zealand will necessitate a much greater focus on growing the health workforce and improving the performance and productivity of the available workforce.
The area in which there has been the most consistent investment in workforce development since the 1990s is mental health. Tauawhitia te Wero, Embracing the challenge: National Mental Health and Addiction Workforce Development Plan 2006-2009, launched in December 2005, emphasises organisational development, and recruitment and retention, includes significant national training and development initiatives, and lays the research and evaluation groundwork to support the next 10-year plan.
A systems perspective on health workforce development
The growing gap between workforce demand and supply will need to be addressed over the next five to 15 years to ensure future population demands associated with our changing demographics and ageing population can be met. The extent to which this will be possible is influenced by policy, regulation, funding, health workforce culture, change weariness and the ability to grow and develop the workforce in the timeframes required.
A significant amount of work has been done, or is underway, to understand changing population demands and service delivery and workforce development needs, and to develop workforce development responses. Considerable workforce development activity is going on across the sector to implement concrete steps towards achieving these high-level outcomes, with current and future activities outlined in Ministry of Health workforce development and DHB/DHBNZ Future Workforce framework.
All of this diverse national workforce development activity can be best understood if it is mapped into a single framework. The rationale for this is that as stakeholders continue to put time and effort into workforce development, there is a risk that actions may become fragmented and duplicated. Efficiencies possible through utilising, for example, nationally consistent information collection and reporting systems, clear networks of relationships and communication processes, and shared terminology can be achieved through understanding how each stakeholder’s valuable efforts fit together into the big picture.
The mental health workforce development framework has been used to provide a comprehensive overview of workforce development activity. The activity is summarised as follows.
Summary of workforce development activity in Ministry of Health workforce development plans and DHB/DHBNZ Future Workforce framework
1. Workforce development infrastructureGoal: A national and regional workforce development infrastructure which supports stakeholders to progress workforce development
Actions:
· Improve national co-ordination of actions.
· Develop collaborative and cross-sectoral relationships.
· Develop funding mechanisms which facilitate new models of care and training.
· Monitor progress on workforce development plans.
· Develop regulatory or other infrastructures to facilitate increased workforce flexibility under the Health Practitioners Competency Assurance Act 2003.
2. Organisational development
Goal: Health services develop the organisational culture and systems which will attract and grow their workforce and meet service needs
Actions:
· Improve leadership capacity and practice (particularly by under-represented workforce groups).
· Increase the range of health workforce groups involved in governance.
· Develop innovative models of care and support (eg, continuum of care approach, primary health teams).
· Improve healthy workplace environments and practices (eg, magnet hospitals).
· Align workforce with service needs (ie, identify and plan to address service gaps).
3. Recruitment and retention
Goal: Health services have a nationally and regionally co-ordinated approach to recruiting and retaining staff, which results in increased capacity and capability of the health workforce
Actions:
· Establish national advertising and branding campaigns (including websites).
· Implement career pathways and co-ordinated professional development programmes.
· Develop strategies to train and recruit under-represented groups within the health workforce (Māori, Pacific, Asian workforces).
· Deliver health career promotion in schools.
· Support new staff through the transition from training to practice.
· Support the development of career pathways for the development the unregulated workforce.
4. Training and development
Goal: All stages of health workforce training are aligned to service needs and promote retention
Actions:
· Establish an agreed set of core competencies which are portable across disciplines.
· Develop and deliver training to support new models of care.
· Establish a set of cultural competencies within training programmes to improve service delivery to cultural groups and recruitment of staff from them.
5. Information, research and evaluation
Goal: Information and research are available to support workforce development planning
Actions:
· Ensure the collection of workforce information is robust, uniform and nationally co-ordinated.
· Improve information-sharing mechanisms.
· Develop the ability to monitor and evaluate the structure of the health workforce and its activities (HPCAA processes).
· Undertake surveys of existing workforce groups
When the Ministry of Health’s workforce development plans and DHB/DHBNZ’s Future Workforce framework are summarised in this way, a high level of continuity and activity is clearly apparent.
Achieving these changes needs a combined approach which provides incentives for local innovation, at the same time as addressing structural issues at the national level. This will need to be supported by a change management process which engages all agencies and groups within the sector.